CPT 81237 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Genetic Analysis Procedures Tier 1 Molecular Pathology Procedures |
| Common Place of Service | 81 - Independent Laboratory |
| Common Modifiers | None 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 81237 |
National average reimbursement for CPT 81237 by major payers:
$142.82
$107.60
$157.90
$275.88
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 81237 | $175.22 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 81237 | $96.47 | 1053725994 - HANS HENRIQUEZ | 363950044 - PROGRESSIVE MEDICAL CENTER, S.C. | IL | Internal Medicine Physician (207R00000X) |
United | 81237 | $175.40 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81237 | $73.66 | 1023438009 - MOLLY MCINTOSH | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Home Health Agency (251E00000X) |
United | 81237 | $73.67 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Ophthalmology Physician (207W00000X) |
United | 81237 | $263.10 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
United | 81237 | $231.53 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81237 | $105.24 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 81237 | $73.67 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 81237 | $385.88 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81237 | $73.66 | 1174078281 - DERMATOLOGY AND SKIN CANCER SURGERY CENTER, LLC, ORLANDO DERMATOLOGY CENTER | 208048424 - (FL) DERMATOLOGY AND SKIN CANCER SURGERY CENTER LLC | FL | Dermatology Physician (207N00000X) |
United | 81237 | $94.72 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 81237 | $105.24 | 1033320049 - ANN STECK | 10877201 | OH | Family Medicine Physician (207Q00000X) |
United | 81237 | $385.88 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 81237 | $73.66 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 81237 vs. Other Tier 1 Molecular Pathology Procedures Codes
The CPT 81237 code is part of the Genetic Analysis Procedures services used for Tier 1 Molecular Pathology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 81237 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 81230-CPT | Low | Genetic Test For Drug Therapy, A Lab Test That Evaluates How Well A Drug Is Metabolized By The Body. This Helps To Identify The Most Effective Drug Therapy And The Likelihood Of Developing Severe Side Effects. |
| 81231-CPT | Low | Genetic Test For Drug Therapy, A Lab Test That Evaluates How Well A Drug Is Metabolized By The Body. This Helps To Identify The Most Effective Drug Therapy And The Likelihood Of Developing Severe Side Effects. |
| 81232-CPT | Low | Genetic Test For Drug Therapy, A Lab Test That Evaluates How Well A Drug Is Metabolized By The Body. This Helps To Identify The Most Effective Drug Therapy And The Likelihood Of Developing Severe Side Effects. |
| 81237-CPT | Low | Ezh2 (Enhancer Of Zeste 2 Poly, Ezh2 (Enhancer Of Zeste 2 Polycomb Repressive Complex 2 Subunit) (Eg Diffuse Large B-Cell Lymphoma)Gene Analysis Common Variant(S) (Eg Codon 646) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81237. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81237 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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